Op-Ed: To Stem the Opioid Epidemic, NJ Must Take Care of Prison Population

Aakash Shah, Pranay Nadella | February 6, 2019 | Opinion
Giving prisoners medication assisted treatment — and continuing it on their release — would offer them a good chance of recovery, rehabilitation and reintegration

Pranay Nadella and Aakash Shah
“Sometimes I just wish I had diabetes,” Jon said. “At least then I’d get the medication I need.” Jon was sitting in an emergency room, handcuffed to his stretcher, retching from opioid withdrawal. His struggle with opioid use disorder began when he came across a leftover bottle of oxycontin in the medicine cabinet, escalated to injection heroin use, and recently landed him in prison.

Just prior to incarceration, he had started medication-assisted treatment (MAT) — the use of medications such as buprenorphine, methadone, or naltrexone in conjunction with counseling and related therapies — to stave off cravings and prevent relapse. He was convinced that it was the biggest step toward recovery that he had taken in months. And with good reason. Multiple studies show that MAT cuts the risk of overdose in half and doubles the chance of recovery. There are few drugs in modern medicine, and certainly no other therapies for opioid addiction, that come close to that type of efficacy.

And yet, patients like Jon typically have this life-saving therapy stopped at the prison or jail gate — only 31 out of the over 5,100 correctional facilities in the country offer MAT, according to one recent investigation.

The result is as predictable as it is heartbreaking. Without treatment, one’s tolerance to opioids wanes, cravings increase, and relapse followed by overdose death becomes increasingly likely. In fact, in the weeks following release, the risk of opioid overdose death among former inmates is 129 times that of the risk within the general population, making this period the most dangerous in the life of a patient with opioid use disorder. Thus, the tragic reality is that we unwittingly permit those with opioid use disorder who have “done their time” to then suffer a de facto death sentence upon release. As Jon noted that day in the emergency room, between bouts of retching, we would never restrict diabetics’ access to the life-saving medications that they need. Too often, however, we do exactly that to patients like Jon.

Our state’s leaders recently announced their intent to change that reality in earnest here in New Jersey. We strongly applaud their efforts and encourage them to learn from the experiences of three other states — Rhode Island, Massachusetts, and Texas — that have succeeded on this front.

What works for one patient may not work for another

First, access to all three types of MAT — buprenorphine, methadone, and naltrexone — in conjunction with counseling and more traditional therapies is key. Providers in Rhode Island have shared anecdote after anecdote about how what works for one patient with an opioid use disorder may not work for another. As a result, Rhode Island ensured inmates access to all three medications so that patients could continue whichever one worked best for them. The result was noticeable, as after initiation of this policy, researchers found a 60.5 percent decrease in opioid overdose deaths among the previously incarcerated.

Second, access to MAT must continue in the community upon release. Far too often, the previously incarcerated fall off Medicaid and are unable to establish reliable access to care, much less addiction treatment specialists. Unfortunately, this is even more true in states like New Jersey, where barriers such as prior authorization requirements to prescribe MAT to Medicaid beneficiaries still exist. In response to this challenge, Massachusetts employs navigators to ensure that individuals leaving correctional facilities are subsequently able to connect with MAT providers in the community. While employing navigators may seem cumbersome and expensive, Massachusetts has found that the program returns $6.27 for every dollar invested and has resulted in a roughly 10 percent reduction in crime.

Third, access to support and wraparound services are essential. In Texas, the state couples MAT upon release with therapy, coaching, and broader social services. This comprehensive approach recognizes that the road to recovery requires stable housing, job training and placement, legal assistance, and additional supports. While providing reliable and effective wraparound services is difficult, New Jersey already has the infrastructure — including through organizations like New Jersey Reentry Corp — to do so. Coupling the provision of MAT to these services can go a long way in turning the tide against the opioid crisis in our state.

For the state of New Jersey, these policy responses would not only help stem the opioid epidemic but make economic sense. Several studies show that MAT for correctional patients reduces the risk of recidivism and, in turn, prison costs (the cost of incarceration in New Jersey is over $50,000 per inmate per year).

Ultimately, these policy solutions are most important because of how they would help Jon and patients like him. With MAT beginning in prison and continuing into the community along with broader social services, Jon would have a meaningful chance at recovery, rehabilitation, and reintegration as a productive member of society.